This is a decisive moment for our health care system. In the face of staff shortages, an aging population and increased patient volume, it is time to take action. For too long, hasty cost-cutting exercises have become a political and organizational reflex, with extreme repercussions for nurses and patients. It is well-established that nurse staffing levels are crucial to both optimizing quality of care and controlling costs in the long run – not just the short-term.

As the largest clinical subgroup - at almost 40% of operating costs - nurses have been an easy target for reduced hours and other cutbacks. Despite this, the American Nurses Association (ANA) is hopeful for the future. With health care reform, comes the opportunity to place nurses at the forefront of our health care system. By recognizing the true impact of nursing, we can lead the change that will both address the nation’s staffing crisis and improve health care for everyone.

The clinical case for adequate nurse staffing levels

The business sense behind optimal nursing staff levels is irrefutable. From hospital admission to discharge; care coordination to ongoing patient education, nurses facilitate the entire health care journey. The appropriate staffing level reduces mortality rates, the length of patient stay and a number of preventable events such as falls and infections. While patient safety benefits, so too do nurses. With an improved workload comes the chance for nurses to utilize their full expertise, without the pressure of fatigue.

To explore the clinical case for the effect of nurse staffing models, we collaborated with health care insight leaders Avalere and a panel of top nurse researchers, thought leaders and managers. The white paper concludes that staffing levels in a value-based health care system should not be fixed, as day-to-day hospital requirements are constantly in flux.

The report recommends that staff levels depend on a number of factors.

Staff Level Factors

Patient complexity, acuity, or stability

Number of admissions, discharges, and transfers

Professional nursing and other staff skill level and expertise

Physical space and layout of the nursing unit

Availability of technical support and other resources

Empower nurses to addresses the staffing crisis

It is clear that nurses are best-placed to make a judgement on staffing levels. From patient complexity, to layout of the nursing unit; nurses know the provision that they and their team need. In the face of limited federal intervention, ANA supports a legislative model with nurses sanctioned to create flexible staffing plans for their unit. Not only would nurse-to-patient ratios improve, but nurses would be able to support each other when most needed.

This is just another instance where health care would be improved by greater nurse involvement. It is crucial for nurses to take on leadership roles, in all settings, to meet the demands of our ever-changing health care system. The Institute of Medicine (IOM) report details this further, with suggestions on how nurses should be supported to achieve greater responsibility:

Nurses should practice to the full extent of their education, training and licensure.

Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.

Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States.

The future of nursing requires action

Staffing solutions must evolve to cope with the full weight of the health care system, and flexible staffing plans are just the beginning. Organizations must be held accountable for their operations, and public reporting is critical in ensuring this transparency. Every nurse can make a difference, too. Write to your member of Congress and urge them to support Safe Staffing or share your stories of nursing on the front line.

Additional Resources

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